title: The role of toothpaste in the aetiology and treatment of dentine hypersensitivity.
abstract: Dentine hypersensitivity (DH) is a common, painful dental condition with a multi-factorial aetiology. The hydrodynamic mechanism theory to explain dentine sensitivity also appears to fit DH: lesions exhibiting large numbers of open dentinal tubules at the surface and patent to the pulp. By definition, DH can only occur when dentine becomes exposed (lesion localisation) and tubules opened (lesion initiation), thus permitting increased fluid flow in tubules on stimulation. Erosion, particularly from dietary acids appears to play a dominant role in both processes. Toothbrushing with most toothpaste products alone cause clinically insignificant wear of enamel but are additive, even synergistic, to erosive enamel loss. Additionally, toothbrushing with toothpaste is implicated in 'healthy' gingival recession. Toothbrushing with most toothpastes removes the smear layer to expose tubules and again can exacerbate erosive loss of dentine. These findings thereby implicate toothbrushing with toothpaste in the aetiology of DH. Management of the condition should have secondary prevention at the core of treatment and therefore, must consider first and foremost the aetiology. Fluoride toothpaste at present appears to provide little primary or secondary preventive benefits to DH; additional ingredients can provide therapeutic benefits. Potassium-based products to block pulpal nerve response have caused much debate and are considered by many as unproven, which should not translate to ineffective. Several toothpaste technologies formulated to block tubules are from studies in vitro, in situ and controlled clinical trials considered proven for the treatment of DH.
authors.affiliation: School of Oral and Dental Science, University of Bristol, Bristol, UK.
authors.forename: M
authors.initials: M
authors.lastname: Addy
authors.forename: N X
authors.initials: NX
authors.lastname: West
mesh_terms: D003804:Dentin / Q000187:drug effects / Q000648:ultrastructure; D057133:Dentin Desensitizing Agents / Q000627:therapeutic use*; D003807:Dentin Sensitivity / Q000188:drug therapy / Q000209:etiology*; D019234:Dentinal Fluid / Q000187:drug effects / Q000502:physiology; D006801:Humans; D016369:Smear Layer; D014077:Tooth Erosion / Q000150:complications; D014099:Toothbrushing / Q000009:adverse effects; D014100:Toothpastes / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D057133:Dentin Desensitizing Agents; D014100:Toothpastes